Chemicals in Hospital Cleaning Products May Affect Workers' Health

Deborah Brauser

April 01, 2009

April 1, 2009 — Many chemical ingredients found in common hospital cleaning products can affect workers' health through air and dermal exposures, according to results of a pilot study reported in the March issue of Environmental Health.

"In recent years, cleaning has been identified as an occupational risk because of an increased incidence of reported respiratory effects, such as asthma and asthma-like symptoms among cleaning workers," write Anila Bello, MS, from the Work Environment Department at the University of Massachusetts Lowell, and the Department of Environmental Health at the Harvard School of Public Health, Boston, Massachusetts, and colleagues. However, because of "the lack of systematic occupational hygiene analyses and workplace exposure data, it is not clear which cleaning-related exposures induce or aggravate asthma and other respiratory effects."

This study sought to identify ingredients of concern with respect to respiratory and skin irritation and sensitization and to assess the potential for inhalation and dermal exposures during common cleaning tasks.

The investigators prioritized potentially hazardous ingredients in a set of cleaning products commonly used in 6 hospitals in eastern Massachusetts. In addition, they sought to identify specific cleaning tasks associated with higher potential for exposure during product applications.

Methods used included workplace interviews and reviews of product Materials Safety Data Sheets, scientific literature on adverse health effects of cleaning product ingredients in humans, the physicochemical properties of cleaning ingredients, and occupational hygiene observational analyses. The investigative team also conducted a qualitative assessment of airborne exposures (with 3 exposure categories: low, medium, and high) and a semiquantitative assessment of dermal exposures using the Dermal Exposure Assessment Method (DREAM).

Examples of common tasks performed and observed included floor finishing and cleaning of floors, mirrors, windows, toilet bowls, sinks, and counters. The major product lines used included general purpose cleaners, glass cleaners, washroom cleaners, and floor-finishing products.

Results showed that ingredients of concern include quaternary ammonium compounds, glycol ethers such as 2-butoxyethanol, and ethanolamines.

In addition, cleaning workers were found to be at risk for acute and chronic inhalation exposures to volatile organic compound (VOC) vapors and aerosols from product spraying, as well as dermal exposure, mostly through their hands.

Tasks classified as "high exposure" included combination jobs, such as cleaning of patient rooms and bathrooms. "Due to the continuous application of many products one after another, the potential for inhalation exposures can be higher compared to when the tasks are performed separately," explain the investigators. "Because these tasks are done in small volume environments, it is possible that airborne VOC can increase rapidly in a short period of time exposing the worker to inhalation risks." Floor-finishing tasks such as stripping, waxing, and buffing were also classified as "high" for inhalation exposure.

The DREAM categories found a high potential for dermal exposure in tasks such as the cleaning of mirrors/windows, sinks, and toilet bowls.

Limitations of this study include the small number of products evaluated and that the study does not address the lack of quantitative data in the literature regarding the concentrations of cleaning compounds in workplace air.

"Cleaning products are complex mixtures of many chemicals," the study authors conclude. "A combination of product evaluation with workplace exposure assessment is critical in developing strategies for protecting workers from cleaning hazards." They add that their classifying of tasks into different exposure categories can help in future epidemiologic investigations related to cleaning. "The methods presented here can be used by occupational and environmental health practitioners to identify workplace interventions for improving health."

The authors have disclosed no relevant financial relationships.

Environ Health. Published online March 27, 2009.

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